The epidemiology of infectious diseases among South American Indians: a call for guidelines for ethical research

With alarming frequency, the native peoples of South America continue to become victims of neglect and abuse. Such incidents rarely come to public attention, and in the few instances in which we learn about them remedial action is rarely taken. Who is to blame for this and what can be done to prevent the extinction of indigenous groups during the 21st century are simple questions for some social critics—notably Patrick Tierney, author of the recent and much publicized book Darkness in El Dorado (2000). Unfortunately, Tierney’s journalistic enthusiasm for sensational allegations directed at a few individuals trivializes the complex causes of the plight of the region’s native peoples (Hurtado 1990) and draws attention away from the kind of analysis that can produce lasting solutions. One of Tierney’s most serious charges is that medical scientists and anthropologists caused epidemics among the Yanomamo of Venezuela over 30 years ago. Journalists are not trained to decide such things; epidemiologists are, and they are unlikely to claim to know what caused an epidemic many years after it took place. They find it difficult enough to do so in the midst of an epidemic. The work is very time-consuming and costly and requires experts from multiple public health disciplines with a great deal of experience in collecting and analyzing valid and accurate quantitative data. We may never know the who, when, and how of the origins of the measles and malaria epidemics of the mid-1960s in Yanomamo communities, just as we may never know why a measles epidemic broke out among Angaite communities in the Paraguayan Chaco in January of this year (Ultima Hora, January 15, 2001). What we do know is that the vast majority of epidemics occur when medical sci